Guided Drug List 3-Tier
The Guided Drug List is a list of prescription medications approved by
the U.S. Food and Drug Administration (FDA). We’ve reviewed these drugs through
our Pharmacy and Therapeutics (P&T) Process, which considers a drug’s:
- Effectiveness
- Safety
- Similarity to other drugs within
a therapeutic class
- Affordability
PLEASE NOTE: Your coverage has
limitations and exclusions. This means that some drugs on this list may
not be covered, depending on your plan’s design. For example, your
plan might not cover certain drugs for cosmetic uses or to treat conditions
such as weight loss, infertility, or erectile dysfunction. To find out if your
drug is covered, log into your member portal or use the mobile app to Price
a Medication and refer to your plan documents.
Search
by medication name for up-to-date drug information, including the benefit tier
your drugs are on, as well as applicable clinical edits such as prior
authorization or step therapy requirements.
Preventive care drugs: We cover preventive care drugs with
zero cost share in compliance with the Affordable Care Act (ACA). We cover
contraceptives for members enrolled in a California plan according to state
regulations.
Member cost share amounts for certain abuse-deterrent
opioid analgesics may be lower in the state Maine due to state laws. For
additional information, please call the Pharmacy Member Services number on your
ID card.
Most plans include our home delivery program at no extra cost to
you. Find out
more by calling the Pharmacy Member Services number on the back of your ID card
or by logging into your secure member portal.
To our providers: Our electronic prior authorization (ePA) process is the preferred method
for submitting pharmacy prior authorization requests. Creating an account
is free, easy and helps patients get their medications sooner. You can
complete the process through your current electronic health record/electronic
medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts®
Log in to CoverMyMeds®
This drug search tool will be updated
at least quarterly.